Sept. 14, 2000 - The quality of Colorado managed-care plans is improving but there are still significant differences in health plans' medical practices and customer-service records, according to a Colorado Business Group on Health study released Wednesday.

HMOs in Colorado in 1999 gave more eye exams to diabetic patients, prescribed more beta blockers for heart attack victims and immunized more children than the year before, but many still lag far behind benchmarks set by the National Commission on Quality Assurance, said Donna Marshall, executive director of the Colorado Business Group on Health.

Patient satisfaction is a big problem, with 51 percent of health-plan members surveyed by the nonprofit coalition reporting customer-service problems. Thirtyeight percent of HMO members said they had problems choosing a primary-care physician and 30 percent reported difficulty getting a referral to a specialist.

As in past years, smaller regional plans Rocky Mountain HMO and Health Network of Colorado Springs scored the highest percentage of perfect 10 ratings from members. Aetna U.S. Healthcare, Anthem Blue Cross Blue Shield of Colorado and PacifiCare of Colorado, some of the state's largest health plans, ranked lowest.

Blue Cross Blue Shield spokesman Don Stengele said the plan has made significant improvements since 1999 when it was in the throes of its conversion from a nonprofit to for-profit company and its subsequent sale to Anthem Inc. One measure of its improvement is its attainment this week of a commendable accreditation from the National Commission on Quality Assurance, he said.

PacifiCare of Colorado blamed its relatively poor satisfaction ratings on highly publicized battles with physicians and said perception should improve with the stabilization of its physician network this year.

Double-digit premium increases scheduled for 2001 and a narrowing gap between the price of HMO plans and less restrictive, preferred-provider organizations, or PPOs, are pushing employers and consumers to look at HMO quality more closely than in past years, said industry experts.

"We aren't the lowest-cost health plan out on the street today, but our growth has shown that people are willing to pay a little more and get a plan that's focused on quality, customer service and (physician) network stability," said Daryl Edmonds, chief executive officer of Cigna Healthcare of Colorado, which ranked first among point-of-service, or POS plans, and topped all managed-care plans with 100 percent use of beta blocker drugs on heart patients. Cigna has grown by more than 100,000 members this year. Similarly, Grand Junction-based Rocky Mountain HMO grew by 17,000 members during the same period.

"We've always taken a position that we are never going to be cheaper because of our emphasis on quality," said Mike Weber, Rocky Mountain HMO founder and chief executive officer.

But for small businesses hit by the most severe price increases, quality may be a luxury that's out of reach financially, said insurance brokers.

"The small employers don't have much choice,' said George Ketchel, senior vice president at Marsh Inc., an insurance brokerage and consulting firm. "The rate hikes that are coming down, they're coming down pretty heavy."

Choosing a health plan with an excellent clinical track record can be an invaluable decision for those with serious medical problems, however.

"Most of the health plans have (disease management) programs, most are not stellar, but it makes a big difference in a patient's ability to manage disease and it can have a huge impact on their long-term health," Marshall said.

For healthier consumers who use their benefits less frequently, customer service is often the defining element driving satisfaction, said health-plan executives.

"When you measure quality of care in the hospital, the health-care community is going to look at infection rates and how quickly a patient recovers after being discharged," said Dr. Bill Wright, assistant medical director for primary care and quality at Kaiser Permanente of Colorado.

"A patient looks at whether the nurse came right away when they called, did the carpet look good, how long was the wait in the doctor's office. ..." Last year, Kaiser Permanente, one of the state's largest HMOs with more than 300,000 members, ranked near the bottom when it came to things such as access to the same physician and getting questions answered quickly. The health plan has dramatically improved, he said.

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